Depression no bar to Medicare drug plan enrollment

NEW YORK (Reuters Health) - Medicare's new prescription drug program is known for its complexity, which can be confusing even for perfectly healthy people not distracted by medical or mental health issues. However, a new study shows that people with depression or impaired thinking had no more difficulty signing up for the program than individuals without depression or other mental difficulties.

The jury's still out, however, on how these individuals fared once they enrolled in Medicare Part D, which allows seniors to get prescription drug coverage through private health care plans.

The Medicare Modernization Act of 2003 added the prescription drug benefit to Medicare for the first time, Dr. Kira Zivin of the University of Michigan Medical School in Ann Arbor and her colleagues explain in their report. But concerns had been raised about whether or not mentally ill or cognitively impaired people might have trouble dealing with the complexities of the new system, Zivin, also of the Ann Arbor VA Medical System, noted in an interview.

Adding to the potential for problems, Medicaid dropped its prescription drug coverage for all enrollees who were also receiving Medicare coverage to as of January 2006, when Medicare Part D became available. Almost a third of the 6.4 million people who are eligible for both Medicaid and Medicare are mentally ill.

To investigate these concerns, Zivin and her team looked at data for 2004 and 2006 from the Health and Retirement Study (HRS), as well as a subset of HRS called the Prescription Drug Study (PDS). Study participants were asked in 2005 whether or not they planned to enroll in Medicare Part D; about half said they probably wouldn't, 28% said they probably would, and 23% said they didn't know.

In 2006, researchers asked HRS participants if they had enrolled. The 2004 and 2006 HRS analyses included 9,733 people, and 42% of them had Medicare Part D coverage in 2006.

In both the HRS and the PDS groups, roughly 13% were depressed, 2.5% had symptoms of cognitive impairment, and about 1% had both.

The researchers found that people with depression or cognitive impairment were 2.6 times more likely than people without these problems to have signed up for Medicare Part D.

But after Zivin and her team adjusted for factors that could influence both enrollment and mental health problems such as level of education, health, and age, they found the impaired or depressed people were no more-or less-likely to enroll than the mentally healthy.

Specifically, 40% of people with no depression or mental impairment enrolled in Medicare Part D, compared to 47% of people with depression, 45% of people with mental impairment, and 63% of people who were both depressed and mentally impaired.

As a group, the depressed or cognitively impaired people were poorer, sicker, used more medications and more likely to have Medicaid coverage, Zivin and her team write. "These relatively disadvantaged individuals may have had greater incentives to obtain Part D coverage than healthier or richer counterparts with fewer medication needs," they say.

What the findings can't show, Zivin said, is how easily depressed and cognitively impaired people were able to obtain needed medications once they enrolled in the program. She and her colleagues are now investigating this question.